VBAC (Vaginal Birth After Cesarean)

Some doctors feel that if you have had one previous Cesarean, you may be a candidate for a chance at vaginal birth.

There are risks associated with attempting VBAC, such as the possible risk of uterine rupture (tearing of the uterus in the area of the prior C/S scar). Uterine rupture can have serious consequences, including hemorrhage, blood transfusion, hysterectomy, placental separation and/or oxygen deprivation to the baby, rarely leading to fetal brain injury and/or death. Uterine ruptures can occur suddenly and unpredictably, without any advance warning.

Recent data suggests that these risks are higher than previously believed. Based on recent literature regarding the risks of attempting VBAC, we no longer offer this option to our patients (with rare exceptions).

What follows is my personal opinion (Dr. Jick)

The 1% rule

In obstetrics, if there is a procedure or treatment that can injure a patient 1% of the time, we usually will not offer this treatment unless there is no choice. In the past, women with breech babies were allowed to deliver vaginally. Many studies eventually showed that 1% of the time, there was a bad outcome.

Vaginal breech is rarely practiced nowadays.

Research has consistently shown that in about 1% of attempted VBAC, there is a bad outcome. Yet, many people still widely promote VBAC. Why is this?

Birthing has financial and political implications, and it is important to look at who is promoting VBAC. Insurance companies, Kaiser Health Systems and anti-C/S organizations still promote VBAC, despite evidence of it's risks.

If a 1% risk is enough to stop allowing vaginal breech births, then it should be enough to stop allowing VBAC.